Curbing Covid’s assault on kids’ mental health

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Apr 07, 2023 View in browser   By Daniel Payne and Krista Mahr Presented by With Carmen Paun and Ben Leonard Driving the Day Doctors are seeing an increasing number of kids with depression, anxiety and other mental disorders post-pandemic. | AP Photo NO END IN SIGHT — America’s pandemic response may be winding down, but the number of children being treated for mental health disorders isn’t slowing, your host reports. That’s leaving doctors concerned that the worst effects of the pandemic could still be ahead. Kids might not display symptoms of mental illness, such as anxiety or depression, for quite some time after experiencing a traumatic event like the pandemic, which destabilized their lives, pediatric experts say. That could mean a host of mental illness diagnoses associated with the pandemic will emerge in coming years. Still, providers say the pandemic’s early effects have already significantly stressed health systems, likely because of disrupted care over the last three years. Those delays in care can cause conditions to worsen over time and further compound the systemwide strain. A government response? In recent months, lawmakers have seen mental health and substance use issues as rare bipartisan points of agreement, especially after the passage of the Bipartisan Safer Communities Act and the inclusion of mental health provisions in the omnibus package passed late last year. Some look to use that momentum to push new legislation. Sen. Bob Casey (D-Pa.) plans to introduce three bills aimed at improving mental health care for kids, one of his aides told POLITICO. One bill, set to be reintroduced soon, would create grants for children’s mental health services and make them more accessible. Another would help gather more accurate national data on mental health and children, and the third would focus on the mental health of kids in foster care. And children’s health providers tell government leaders it’s now critical that the federal government step up support for an overburdened system, arguing for increased funding for graduate medical education programs and boosted government reimbursement rates for mental health services. Some health experts compare the sustained caseload of mental health patients to the stress Covid-19 put on the larger health system. “The toll from the pandemic on kids didn’t happen between 2020 and 2023. It’s going to happen from now into the next five to 10 [years],” said Jeff Sperring, a pediatrician and the board chair of the Children’s Hospital Association. “The impact of this pandemic for kids was different. We haven’t seen it yet, and it’s coming.” WELCOME TO FRIDAY PULSE. There are a lot of flashy headlines these days about hallucinogens’ medical possibilities, but the drugs are nothing new — a recently discovered human hair dated to the Bronze Age tested positive for similar substances. What’s the next big discovery on the horizon? Let us know — and keep the tips coming — at dpayne@politico.com and kmahr@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Ben Leonard talks with Daniel, who expands on his report on the pandemic's negative impact on kids’ mental health and the legislation being proposed to help combat Covid’s effect. Plus, Katherine Ellen Foley provides a dispatch from this week’s World Vaccine Congress in Washington. Listen to today’s Pulse Check podcast   A message from PhRMA: Did you know that the three largest PBMs blocked access to more than 1,150 medicines last year? That includes medicines that could lower your costs at the pharmacy. Pharmacy benefit managers are putting their profits before you. Haven't heard about this? That’s by design.   HEALTH TECH The death of four veterans have been indirectly associated with the VA's troubled electronic health records system. | AP Photo MORE ON VA’S EHR WOES — The Department of Veterans Affairs revealed new details in response to a POLITICO inquiry about problems with its new electronic health records system, acknowledging that the system had played a role in “catastrophic” harm to six veterans, four of whom died, Ben reports. While the records system didn’t “directly cause” the deaths, the system’s configuration, workflow changes and training and staffing all contributed to the patients’ harm, an agency spokesperson told POLITICO. The new details shed more light on the severity of the flaws in the digital medical records system from VA contractor Oracle Cerner. The system has previously misrouted orders for prescriptions and requests for exams, leading to delays in care, according to the VA Inspector General. “Any injury or loss of life is simply unacceptable. We grieve for these Veterans and extend our deepest condolences to their loved ones,” the VA spokesperson said. “[We] will not rest until we’ve done everything possible to prevent tragedies like this from happening again.” Oracle Cerner didn’t return a request for comment.   A message from PhRMA:   Global Health PANDEMIC TREATY TALKS NOT IN ‘A STALEMATE’ — Wealthy and low-income countries can’t agree on much as they negotiate an international pandemic accord to avoid some of the mistakes made in response to Covid-19, but a World Health Organization top official denied the talks have reached an impasse, Carmen reports. “Definitely not a stalemate, definitely moving forward,” Bruce Aylward, senior adviser to the WHO director-general, told reporters Thursday. What it’s about: A leaked draft of the negotiating text for an international treaty on pandemic prevention, preparedness and response, dated March 3 and obtained by POLITICO's Ashleigh Furlong, shows opposing suggestions from dozens of countries on crucial issues such as access to pandemic vaccines and treatments. Negotiators have just begun discussing the text, with edits focused on the treaty’s definitions, objective and principles instead of the meat of the proposal. They would need to have a final text ready for adoption at the World Health Assembly meeting in May 2024, a timeline some have called ambitious. The divides are playing out in a familiar way: Developing countries, including Brazil, Namibia and China, want “unhindered” access to pandemic products to be guaranteed in the treaty, while the U.S. and Australia request that the word unhindered be deleted from the text. Another sticking point includes requests from Canada and the U.S. that the sharing of technology and know-how be on “voluntary” or “mutually agreed” terms, while many developing countries want to remove those qualifiers, Ashleigh reports. Why it matters: The negotiations are testing countries’ commitments to avoid the mistakes of the current pandemic, which saw inequities among countries play out in terms of access to Covid-19 vaccines, tests, treatments and protective equipment. CHINA: FENTANYL IS A MADE-IN-THE-USA PROBLEM — The root cause of tens of thousands of people dying from fentanyl use in the U.S. is a problem of America’s making, and the U.S. shouldn’t blame China or Mexico for it, a Chinese official told reporters in Beijing on Thursday. “The US needs to face up to its own problems, take more substantial measures to strengthen domestic regulation and reduce demand,” said China’s foreign ministry spokesperson Mao Ning. She was addressing a query about a letter Mexican President Andrés Manuel López Obrador sent to Chinese leader Xi Jinping asking him to help control shipments of fentanyl into Mexico. The letter came after a meeting between Obrador and a delegation of U.S. lawmakers in mid-March when the Mexican president promised to write to Xi asking for cooperation. But Mao said Thursday that “there is no such thing as illegal trafficking of fentanyl between China and Mexico” and the two countries “have a smooth channel of counternarcotics cooperation, and the competent authorities of the two countries maintain sound communication.” Mao also said Mexico hasn’t notified China about any seizure of chemicals controlled in China that can be used to produce fentanyl. The Drug Enforcement Administration and other U.S. officials have said that most fentanyl coming into the U.S. is produced by Mexican drug cartels with so-called precursor chemicals from China.   GO INSIDE THE 2023 MILKEN INSTITUTE GLOBAL CONFERENCE: POLITICO is proud to partner with the Milken Institute to produce a special edition "Global Insider" newsletter featuring exclusive coverage, insider nuggets and unparalleled insights from the 2023 Global Conference, which will convene leaders in health, finance, politics, philanthropy and entertainment from April 30-May 3. This year’s theme, Advancing a Thriving World, will challenge and inspire attendees to lean into building an optimistic coalition capable of tackling the issues and inequities we collectively face. Don’t miss a thing — subscribe today for a front row seat.     In Congress DRUG PRICING LEGISLATION — The Senate HELP Committee plans to mark up yet-to-be-seen drug pricing legislation focused on policies related to pharmaceutical middlemen and generic drugs on April 19, POLITICO’s Megan R. Wilson and David Lim report. While the details are still in flux, lobbyists told POLITICO that Chair Bernie Sanders (I-Vt.) wants the panel to consider a bill, which they say Senate Health, Education, Labor and Pensions Committee staffers are still writing, shortly after Congress returns from its spring recess. The bill comes amid efforts from lawmakers to increase access to cheaper generic medicines and criticisms about the lack of transparency into the business practices of pharmacy benefit managers, the middlemen that negotiate discounts with pharmaceutical companies and decide which drugs insurance plans will cover. Drug-pricing legislation has remained top of mind for many lawmakers, even after passage of the Inflation Reduction Act last year, and lawmakers have scrutinized PBMs during recent House and Senate hearings.   A message from PhRMA: Insurers and their PBMs don’t want you to see that you could be paying more than they are for your medicines. Rebates and discounts can significantly lower what insurers and PBMs pay for medicines. These savings can reduce the cost of some brand medicines by 50% or more. But insurers and PBMs aren’t required to share those savings with you at the pharmacy counter. They don’t want you to see that they use deductibles, coinsurance and other tactics to shift more costs on to you. Or that the three largest PBMs control 80% of the prescription drug market. Or that last year they blocked access to more than 1,150 medicines, including medicines that could have lowered costs for you at the pharmacy.  PBMs and insurance practices are shrouded in secrecy,  they need to be held accountable.     What We're Reading The Washington Post reports that assisted-living homes are rejecting Medicaid and evicting older adults. STAT asks where the White House’s new pandemic response office is.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.       Follow us on Twitter Dan Goldberg @dancgoldberg Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Ben Leonard @_BenLeonard_ David Lim @davidalim Krista Mahr @kristamahr Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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